Key facts
- Infertility affects millions of people – and has an impact on their families and communities. Worldwide, it is estimated that approximately one in six people of reproductive age will become infertile during their lifetime.
- The male reproductive system is often infertile due to problems with the ejaculation of semen, a lack of sperm, low levels of sperm production, or distortion (shape) and motility (ability to move).
- The female reproductive system may become infertile due to a combination of abnormalities of the ovaries, uterus, fallopian tubes and endocrine system, among other causes.
- Infertility may be primary or secondary. Primary infertility is the complete inability of a person to achieve pregnancy, while secondary infertility represents the complete inability to achieve pregnancy at least once in the past.
- Fertility care includes preventing, diagnosing and treating infertility. Equal and equitable access to fertility care remains a challenge in most countries; Especially in low and middle-income countries. Fertility care is rarely a priority in national benefit packages for universal health coverage.
Overview
Infertility is a disease that affects the male or female reproductive system and is defined as the inability to achieve pregnancy after regular, unprotected intercourse for 12 months or more. Infertility may result from male, female, or unexplained factors, but some of its causes can be prevented. Infertility treatment often involves in vitro fertilization and other types of medically assisted fertility care.
What are the causes of infertility?
Infertility may result from several different factors in either the male or female reproductive system, but the causes of infertility are sometimes difficult to explain.
The following are the causes of infertility in the female reproductive system:
- Tubal disorders such as blocked fallopian tubes, which in turn result from untreated sexually transmitted disease infections or complications caused by unsafe abortion, postpartum sepsis, or abdominal/pelvic surgery;
- Uterine disorders that may be inflammatory in nature (eg, endometriosis), congenital in nature (eg, septal uterus), or benign in nature (eg, fibroids);
- Ovarian disorders, such as polycystic ovary syndrome and other follicular disorders;
- Disorders affecting the endocrine system cause imbalances in reproductive hormones. The endocrine system includes the hypothalamus and pituitary glands. Examples of common disorders that affect this system include cancers that affect the pituitary gland and hypopituitarism.
The relative importance of these causes of infertility in females may vary from one country to another, for example, due to differences in the prevalence of sexually transmitted disease infections, or differences in the ages of the population groups included in the study.
The following are the causes of infertility in the male reproductive system:
- Reproductive tract obstruction causing impaired semen ejaculation function. This blockage can occur in the tubes that transport seminal fluid (such as the ejaculatory ducts and seminal vesicles). Obstructions usually result from injuries or infections in the reproductive tract.
- Hormonal disorders cause abnormalities in the hormones produced by the pituitary gland, hypothalamus, and testicles - hormones such as testosterone that regulate sperm production. Examples of disorders causing hormonal imbalance include pituitary cancer or testicular cancer.
- Inability of the testicles to produce sperm, due to varicocele or medical treatments, for example, that weaken sperm-producing cells (such as chemotherapy);
- Impaired sperm production function and quality. Fertility is negatively affected by conditions or conditions that cause sperm deformity (shape) and motility (ability to move). For example, the use of anabolic steroids can cause abnormalities in semen parameters such as sperm count and shape (1) .
Fertility can also be affected by lifestyle factors such as smoking, excessive alcohol use, and obesity. In addition, exposure to environmental pollutants and toxins can directly poison the gametes (eggs and sperm), causing their numbers to decrease and their quality to be poor (1,2) .
Why is infertility treatment important?
Every human being has the right to the highest attainable standard of physical and mental health. Individuals and couples also have the right to decide the number of their children and the timing and spacing of births. Infertility can prevent the realization of these basic human rights (3) .
A wide range of people may need infertility management and fertility care services, including heterosexual and same-sex couples, older adults, single individuals, those with certain medical conditions such as some HIV-serodiscordant couples, and HIV/AIDS survivors. cancer. Inequities and disparities in access to fertility care services negatively impact the poor, the unmarried, the uneducated, the unemployed and other marginalized populations.
Infertility treatment can also alleviate gender inequality. Although infertility can affect both women and men, a woman in a relationship with a man is often viewed as infertile regardless of whether she is actually infertile or not. Infertility has significant negative social impacts on the lives of infertile couples, especially women, who are sometimes exposed to violence, divorce, social stigma, emotional stress, depression, anxiety, and low self-esteem.
In some settings, fear of infertility can deter women and men from using contraception if they feel under social pressure to prove their fertility at an early age due to the high social value of childbearing. In such cases, it is essential to implement awareness-raising interventions to address understanding of the prevalence and determinants of fertility and infertility.
Addressing challenges
The availability, accessibility and quality of interventions to treat infertility remain a challenge in most countries. Infertility diagnosis and treatment are often not a priority in national population and development policies and reproductive health strategies, and are rarely included in public health funding. Moreover, the lack of trained staff, equipment and infrastructure, and the current high costs of treatment drugs pose major barriers even for countries active in meeting the needs of people with infertility.
Although assisted reproductive technologies have been available for more than three decades and millions of babies have been born worldwide thanks to the implementation of interventions based on these assisted technologies, such as in vitro fertilization, these technologies remain unavailable, inaccessible and unaffordable until to a significant extent in many parts of the world, especially in low- and middle-income countries.
Government policies may mitigate many of the disparities in access to safe and effective fertility care. To treat infertility effectively, health policies need to recognize that infertility is a disease that can often be prevented, thus reducing the need for treatments that are expensive and not readily available. There are policy and programmatic interventions that all governments can implement, which include integrating fertility awareness into comprehensive national sexual education programs, and promoting healthy lifestyles to reduce behavioral risks, including preventing, early diagnosis and treatment of sexually transmitted disease infections, and preventing complications from unsafe abortion and sepsis. Postpartum and abdominal/pelvic surgery, and treatment of environmental toxins associated with infertility.
In addition, enabling laws and policies regulating third-party assisted reproduction and assisted reproductive technologies are indispensable to ensure access for all without discrimination and to protect and promote the human rights of all parties involved. Once fertility policies are in place, it is indispensable to ensure that their implementation is monitored and the quality of services is continually improved.